One in Five Maternal Deaths in Bangladesh Associated with Acute Jaundice: Results from a National Maternal Mortality Survey

AbstractEducational attainment among women is a well-recognized predictor for maternal mortality. Data from nationally representative surveys and the United Nations are used in the analysis for estimating maternal mortality due to improved education status up to 2030. Analysis of data from 2001 and 2010 Bangladesh Maternal Mortality Survey shows that MMR varies considerably by education level. The study shows that during 2011–2030, 15% maternal deaths will be averted due to fertility change (i.e. fewer births) and 24% of the maternal deaths can be averted only by improving the female education levels. However, in order to achieve the Ending Preventable Maternal Mortality (EPMM) target of 59 maternal deaths per 100,000 live births by 2030 for Bangladesh, a further 64% reduction will be required. Factors outside the health sector, like female education, will continue to have an impact maternal mortality in Bangladesh. However, reaching the EPMM target for Bangladesh by 2030 will also require significant investments in maternal health programs, in particular those to increase access to and quality of services.

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Maternal mortality in six low and lower-middle income countries from 2010 to 2018: risk factors and trends

Reproductive Health ◽

10.1186/s12978-020-00990-z ◽

2020 ◽

Vol 17 (S3) ◽

Author(s):

Melissa Bauserman ◽

Vanessa R. Thorsten ◽

Tracy L. Nolen ◽

Jackie Patterson ◽

Adrien Lokangaka ◽

...

Keyword(s):

Risk Factors ◽

Maternal Mortality ◽

Maternal Deaths ◽

Middle Income ◽

Maternal Risk ◽

Live Births ◽

Middle Income Countries ◽

Risk Of Death ◽

Increased Risk ◽

Over Time

Abstract Background Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time. Methods We analyzed data from women enrolled in the NICHD Global Network for Women’s and Children’s Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time. Results We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI 147, 167) across all sites, with a range of MMRs from 97 (76, 118) in the Guatemala site to 327 (293, 361) in the Pakistan site. When adjusted for maternal risk factors, risks of maternal mortality were higher with maternal age > 35 (RR 1.43 (1.06, 1.92)), no maternal education (RR 3.40 (2.08, 5.55)), lower education (RR 2.46 (1.54, 3.94)), nulliparity (RR 1.24 (1.01, 1.52)) and parity > 2 (RR 1.48 (1.15, 1.89)). Increased risk of maternal mortality was also associated with occurrence of obstructed labor (RR 1.58 (1.14, 2.19)), severe antepartum hemorrhage (RR 2.59 (1.83, 3.66)) and hypertensive disorders (RR 6.87 (5.05, 9.34)). Before and after adjusting for other characteristics, physician attendance at delivery, delivery in hospital and Caesarean delivery were associated with increased risk. We observed variable changes over time in the MMR within sites. Conclusions The MNHR is a useful tool for tracking MMRs in these LMICs. We identified maternal and delivery characteristics associated with increased risk of death, some might be confounded by indication. Despite declines in MMR in some sites, all sites had an MMR higher than the Sustainable Development Goals target of below 70 per 100,000 live births by 2030. Trial registration The MNHR is registered at NCT01073475.

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Maternal mortality during the COVID-19 pandemic in Mexico: a preliminary analysis during the first year

BMC Public Health ◽

10.1186/s12889-021-11325-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nina Mendez-Dominguez ◽

Karen Santos-Zaldívar ◽

Salvador Gomez-Carro ◽

Sudip Datta-Banik ◽

Genny Carrillo

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Maternal Mortality ◽

Respiratory Distress ◽

Pregnant Women ◽

Distress Syndrome ◽

Maternal Mortality Ratio ◽

Maternal Deaths ◽

Immune Impairment ◽

Mortality Ratio

Abstract Background In Mexico, the COVID-19 pandemic led to preventative measures such as confinement and social interaction limitations that paradoxically may have aggravated healthcare access disparities for pregnant women and accentuated health system weaknesses addressing high-risk patients’ pregnancies. Our objective is to estimate the maternal mortality ratio in 1 year and analyze the clinical course of pregnant women hospitalized due to acute respiratory distress syndrome and COVID-19. Methods A retrospective surveillance study of the national maternal mortality was performed from February 2020–February 2021 in Mexico related to COVID-19 cases in pregnant women, including their outcomes. Comparisons were made between patients who died and those who survived to identify prognostic factors and underlying health conditions distribution. Results Maternal Mortality Ratio increased by 56.8% in the studied period, confirmed COVID-19 was the cause of 22.93% of cases. Additionally, unconfirmed cases represented 4.5% of all maternal deaths. Among hospitalized pregnant women with Acute Respiratory Distress Syndrome consistent with COVID-19, smoking and cardiovascular diseases were more common among patients who faced a fatal outcome. They were also more common in the age group of < 19 or > 38. In addition, pneumonia was associated with asthma and immune impairment, while diabetes and increased BMI increased the odds for death (Odds Ratio 2.30 and 1.70, respectively). Conclusions Maternal Mortality Ratio in Mexico increased over 60% in 1 year during the pandemic; COVID-19 was linked to 25.4% of maternal deaths in the studied period. Lethality among pregnant women with a diagnosis of COVID-19 was 2.8%, and while asthma and immune impairment increased propensity for developing pneumonia, obesity and diabetes increased the odds for in-hospital death. Measures are needed to improve access to coordinated well-organized healthcare to reduce maternal deaths related to COVID-19 and pandemic collateral effects.

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Comparative analysis of maternal mortality in the Far Eastern and Siberian Federal Districts

Voprosy ginekologii akušerstva i perinatologii ◽

10.20953/1726-1678-2020-6-117-123 ◽

2020 ◽

Vol 19 (6) ◽

pp. 117-123

Author(s):

T.E. Belokrinitskaya ◽

◽

N.V. Artymuk ◽

O.S. Filippov ◽

E.M. Shifman ◽

...

Keyword(s):

Comparative Analysis ◽

Maternal Mortality ◽

Causes Of Death ◽

Federal District ◽

Siberian Federal District ◽

Obstetric Hemorrhage ◽

Maternal Deaths ◽

Federal Districts ◽

Systematic Development ◽

Far Eastern

Objective. To perform comparative analysis of parameters and structure of maternal mortality (MM) in the Far Eastern Federal District (FEFD) and Siberian Federal District (SFD) in 2014–2019. Materials and methods. The database for analysis was generated using map-based emergency notifications of maternal deaths (69 in FEFD and 180 in SFD). We used methods of descriptive statistics, Pearson's χ2-test, and calculated odds ratios (ORs) with 95% confidence intervals (95% CIs). Results. Between 2014 and 2018, the dynamics of MM in the FEFD and SFD had a one-way trend: it decreased in 2014–2017, but dramatically increased in 2018 primarily due to social factors. In 2019, we observed a significant growth of MM in the FEFD, while the SFD demonstrated a reduction of MM. The most common cause of maternal death in both districts was extragenital diseases. However, there were some differences in the structure of obstetric causes: in FEFD, preeclampsia and obstetric hemorrhage were the most frequent obstetric causes of death, while in SFD, women primarily developed embolism and placental abruption. Conclusion. The dynamics and structure of MM in the FEFD and SFD require management decisions aimed at improving medical care with the consideration of clinical guidelines, organization of continuous audit, systematic development of practical teamwork skills both in simulation training centers and healthcare institutions. Key words: Far Eastern Federal District, maternal mortality, Siberian Federal District

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Two year review of maternal mortality at a tertiary care hospital of GMERS, Valsad, Gujarat, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182336 ◽

2018 ◽

Vol 7 (6) ◽

pp. 2283

Author(s):

Darshna M. Patel ◽

Mahesh M. Patel ◽

Vandita K. Salat

Keyword(s):

Mortality Rate ◽

Maternal Mortality ◽

Rural Areas ◽

Tertiary Care ◽

Maternal Mortality Ratio ◽

Care Hospital ◽

Maternal Deaths ◽

Maternal Mortality Rate ◽

Live Births ◽

Mortality Ratio

Background: According to the WHO, 80 of maternal deaths in developing countries are due to direct maternal causes such as haemorrhage, hypertensive disorders and sepsis. These deaths are largely preventable. Maternal mortality ratio (MMR) in India is 167/100,000 live births.Methods: This retrospective observational study was conducted at GMERS, Valsad. Data regarding maternal deaths from January 2016 to December 2017 were collected and analyzed with respect to epidemiological parameters. The number of live births in the same period was obtained from the labour ward ragister. Maternal mortality rate and Mean maternal mortality ratio for the study period was calculated.Results: The mean Maternal mortality rate in the study period was 413.3/100,000 births. The maternal mortality ratio (MMR) in India is 167/100,000 live births. More than half of maternal deaths were reported in multiparous patients. More maternal deaths were observed in women from rural areas (67.3%), unbooked patients (73.3%) and illiterate women (65.3%). Thirty six (69.3%) maternal death occurred during postpartum period. Most common delay was first delay (60.0%) followed by second delay (40.0%). Postpartum haemorrhage (28.8%), preeclampsia (17.3%), sepsis (13.46%) were the major direct causes of maternal deaths. Indirect causes accounted for one third of maternal deaths in our study. Anemia, hepatitis and heart disease were responsible for 13.4%, 5.7%, and 1.9% of maternal deaths, respectively.Conclusions: Majority of maternal deaths are observed in patients from rural areas, unbooked, and illiterate patients. Hemorrhage, eclampsia and sepsis are leading causes of maternal deaths. Most of these maternal deaths are preventable if patients are given appropriate treatment at periphery and timely referred to higher centers.

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Universal Maternal Rights: A Matter of Life and Death

10.21467/preprints.333 ◽

2021 ◽

Author(s):

Alicia Ryan

Keyword(s):

Developing Countries ◽

Maternal Mortality ◽

Obstetric Care ◽

Maternal Deaths ◽

Scientific Methods ◽

Life And Death ◽

The World ◽

Positive Effect ◽

Multiple Obstacles ◽

Maternal Rights

Childbirth has been a part of our lives since the beginning of time. Without the process none of us would be alive today. So why is it that maternal mortality remains one of the greatest inequities in the world? To date, approximately 500, 000 women die annually due to the lack of appropriate prenatal and obstetric care. Difficulties arising with childbirth cannot be predicted. However, the way in which we react to a situation can have a lasting, positive effect on the countries and the women who are at risk. The ways in which to help reduce the large number of maternal deaths in developing countries is not complicated and can be achieved if it is made a priority. In conclusion, there are multiple obstacles in regard to succeeding the highest achievable standard of health globally. With the education of evolving scientific methods, and the collaboration of humanitarian views, the welfare and health of women and their children, can be internationally restored. With the education of evolving scientific methods, and the collaboration of humanitarian views, the welfare and health of women and their children, can be internationally restored.

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Hypertension in Pregnancy Still Remains a Serious Complication Causing Severe Morbidity and Mortality of Mother

Bangladesh Journal of Obstetrics & Gynaecology ◽

10.3329/bjog.v30i2.30900 ◽

2016 ◽

Vol 30 (2) ◽

pp. 92-97

Author(s):

Arife Simsek ◽

Seyfettin Uludag ◽

Ali Benian ◽

Abdullah Tuten

Keyword(s):

Maternal Mortality ◽

Care Center ◽

Tertiary Care ◽

Near Miss ◽

Maternal Near Miss ◽

Maternal Deaths ◽

Hypertension In Pregnancy ◽

Hypertensive Disorders ◽

Mortality Index ◽

Retrospective Examination

Objective(s): The aim of this study is to evaluate frequency and nature of maternal deaths and maternal near-miss cases in a tertiary care hospital.Materials and Methods: A retrospective examination was conducted on records of the16.612 women who delivered in a tertiary care center, over a ten-year period (1997-2006). The flow chart recommended by Say et al was used in the analysis of the maternal near-miss cases.Results: The ratios of mortality related with pregnancy, maternal mortality and maternal nearmiss were 68.11/100.000, 61.29/100.000 and 17.09/1000, respectively. The ratio of maternal near- miss to maternal mortality was 27.8 and the mortality index was 3.46%. Hypertensive disorders were the leading cause of maternal deaths and maternal near-miss events.Conclusion: Hypertensive disorders were still leading cause of maternal deaths and maternal near-miss events.Absence of antenatal care and disrupted referral chains were major problems.Bangladesh J Obstet Gynaecol, 2015; Vol. 30(2) : 92-97

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Maternal mortality-a three-year retrospective study in a rural medical college of India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212947 ◽

2021 ◽

Vol 10 (8) ◽

pp. 3019

Author(s):

Jayasree Hansda ◽

Debobroto Roy ◽

Krishnapada Das ◽

Manojit Sarkar ◽

Rumpa Das ◽

...

Keyword(s):

Maternal Mortality ◽

Maternal Death ◽

Tertiary Care ◽

Maternal Mortality Ratio ◽

Tertiary Care Centre ◽

Maternal Deaths ◽

Demographic Profiles ◽

Medical College ◽

Mortality Ratio ◽

Tragic Event

Background: Maternal mortality is a tragic event as family revolves around a mother. The deadly obstetrical triad of hemorrhage, preeclampsia and infection has accounted for a third of all deaths. This study was conducted to assess maternal mortality ratio, demographic profile and causes of maternal death.Methods: This retrospective longitudinal study was conducted in the department of obstetrics and gynecology for a period of three years from 1st January 2018-31st December, 2020. Total no of death during this period was 134.Records of deaths and demographic profiles were retrieved from the medical record library of aforesaid hospital.Results: There were 134 maternal deaths amongst 56815 live births with MMR 235.85. The majority of deaths were in 20-29 year of age group and most of the deaths seen in multigravida. The 91.79% death was observed within the 24 hours and after 72 hours. Eclampsia, preeclampsia and hemorrhage were leading cause of maternal death seen in the study.Conclusions: Maternal mortality is higher than national MMR. Majority of maternal death were preventable by proper antenatal care, early detection of high-risk pregnancies and their timely referral to tertiary care centre.

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MATERNAL MORTALITY

The Professional Medical Journal ◽

10.29309/tpmj/2009.16.01.3002 ◽

2009 ◽

Vol 16 (01) ◽

pp. 135-138

Author(s):

TASNIM TAHIRA REHMAN ◽

MAHNAZ ROOHI

Keyword(s):

Maternal Mortality ◽

Maternal Death ◽

Maternal Mortality Ratio ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Care Level ◽

Maternal Deaths ◽

Mortality Ratio ◽

Study Setting ◽

Very High

Objective: To find out maternal mortality ratio (MMR) and to determine major causes of maternal death. S t u d y d e s i g n:A descriptive study. Setting: Department of Obstetric and Gynaecology, Allied Hospital, Faisalabad. S t u d y period: From 01.01.2008 to31.12.2008. Materials a n d m e t h o d s : All cases of maternal death during this study periods were included except accidental deaths. Results:There were 58 maternal deaths during this period. Total No. of live births were 5975. MMR was 58/5975 x 100,000 = 970/100,000 live births.The most common cause of maternal death was hemorrhage (34.5%) followed by hypertensive disorders/eclampsia (31%). Most of thepatients (75.86%) were referred from primary & secondary care level. C o n c l u s i o n : Maternal mortality is still very high in underdevelopedcountries including Pakistan. We must enhance emergency obstetric care (EOC) to achieve the goal of reduction in MMR.

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DEMOGRAPHIC AND HEALTH STATUS RISK FACTORS IN CHILDBEARING AMONG INDIAN WOMEN. EVIDENCE FROM HOSPITAL DATA FOR THE LATER STAGES OF FERTILITY DECLINE

Journal of Biosocial Science ◽

10.1017/s0021932000001917 ◽

2000 ◽

Vol 32 (2) ◽

pp. 191-206 ◽

Cited By ~ 1

Author(s):

KIRSTY MCNAY

Keyword(s):

Health Status ◽

Maternal Mortality ◽

Fertility Decline ◽

Poor Health ◽

Low Fertility ◽

Hospital Data ◽

Poor Health Status ◽

Maternal Deaths ◽

Pregnancy And Childbirth ◽

Increase In Risk

Indirect estimates of maternal mortality in India indicate that fertility decline has reduced maternal deaths by reducing the frequency of pregnancy and childbirth. The earlier stages of fertility decline are also likely to have lowered maternal mortality by reducing the risk of pregnancy and childbirth as the proportion of births among risky multiparous, older women declines. However, further fertility decline may well be associated with some increase in risk. Risk will also remain high if the health status of Indian girls and women remains poor. This study uses a sample of maternal deaths and deliveries among patients who survived which occurred in Civil Hospital, Ahmedabad, Gujarat during 1982–1993 to investigate these issues further. The women in the sample have relatively low fertility and represent a fairly late stage of fertility decline. They also have persistently poor health status. Logit regression analysis reveals that although fertility decline is associated with some increase in risk, poor health status is the more important maternal mortality risk factor. Without attention to female health, even childbearing among expectant mothers with low fertility continues to be hazardous.

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